| NPI | 1821170150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: CA A104629) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A104629) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2013-07-31 |